Provider Demographics
NPI:1124092234
Name:COLE, KELLY K (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:K
Last Name:COLE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:330 WALLER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2931
Mailing Address - Country:US
Mailing Address - Phone:859-254-7000
Mailing Address - Fax:859-255-4381
Practice Address - Street 1:330 WALLER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2931
Practice Address - Country:US
Practice Address - Phone:859-254-7000
Practice Address - Fax:859-255-4381
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-06-02
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Provider Licenses
StateLicense IDTaxonomies
KY25949207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3937OtherMEDICARE GROUP NUMBER
KY64259492Medicaid
KYC78305Medicare UPIN
KY0393703Medicare PIN